CNPT 2 Exam 2

Bupropion brand

Wellbutrin, Zyban

Bupropion class

Norepinephrine and dopamine reuptake inhibitor

Bupropion use

Major depressive disorder, seasonal affective disorder, smoking cessation

Bupropion MOA

Inhibits neuronal reuptake of norepinephrine and dopamine

Bupropion dose

IR: 100 mg PO TID, 12h: 150 mg PO BID, 24h: 300 mg PO qAM

Bupropion contraindications

Seizures, bulimia, anorexia, MAO inhibitor use

Bupropion BBW

May cause suicidal thoughts in children and young adults

Escitalopram brand

Lexapro

Escitalopram class

SSRI

Escitalopram use

Major depressive disorder, generalized anxiety disorder

Escitalopram MOA

Selectively inhibits serotonin reuptake

Escitalopram dose

10 mg PO qD

Escitalopram contraindications

None

Escitalopram BBW

May cause suicidal thoughts in children and young adults

Fluoxetine brand

Prozac, Sarafem

Fluoxetine class

SSRI

Fluoxetine use

Major depressive disorder, OCD, panic disorder, premenstrual dysphoric disorder

Fluoxetine MOA

Selectively inhibits serotonin reuptake

Fluoxetine dose

20-80 mg PO qAM

Fluoxetine contraindications

None

Fluoxetine BBW

May cause suicidal thoughts in children and young adults

Sertraline brand

Zoloft

Sertraline class

SSRI

Sertraline use

Major depressive disorder, OCD, panic disorder

Sertraline MOA

Selectively inhibits serotonin reuptake

Sertraline dose

50-200 mg PO qD

Sertraline contraindications

None

Sertraline BBW

May cause suicidal thoughts in children and young adults

Venlafaxine brand

Effexor

Venlafaxine class

Serotonin-norepinephrine reuptake inhibitor

Venlafaxine use

Major depressive disorder, generalized anxiety, panic disorder

Venlafaxine MOA

Inhibits norepinephrine, serotonin, and dopamine reuptake

Venlafaxine dose

75-225 mg PO divided qD-TID

Venlafaxine contraindications

Avoid abrupt withdrawal

Venlafaxine BBW

May cause suicidal thoughts in children and young adults

Paroxetine brand

Paxil

Paroxetine class

SSRI

Paroxetine use

Major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, PTSD

Paroxetine MOA

Selectively inhibits serotonin reuptake

Paroxetine dose

20-50 mg PO qAM

Paroxetine contraindications

None

Paroxetine BBW

May cause suicidal thoughts in children and young adults

Desvenlafaxine brand

Pristiq

Desvenlafaxine class

Serotonin norepinephrine reuptake inhibitor

Desvenlafaxine use

Major depressive disorder

Desvenlafaxine MOA

Inhibits norepinephrine, serotonin, and dopamine receptors

Desvenlafaxine dose

50 mg PO qD

Desvenlafaxine contraindications

Avoid abrupt withdrawal

Desvenlafaxine BBW

May cause suicidal thoughts in children and young adults

Duloxetine brand

Cymbalta

Duloxetine class

Serotonin norepinephrine reuptake inhibitor

Duloxetine use

Major depressive disorder, generalized anxiety disorder

Duloxetine MOA

Inhibits serotonin and norepinephrine reuptake

Duloxetine dose

60 mg PO qD

Duloxetine contraindications

Avoid abrupt withdrawal

Duloxetine BBW

May cause suicidal thoughts in children and young adults

Citalopram brand

Celexa

Citalopram class

SSRI

Citalopram use

Major depressive disorder

Citalopram MOA

Selectively inhibits serotonin reuptake

Citalopram dose

20-40 mg PO qD

Citalopram contraindications

Electrolyte abnormality, QT prolongation, arrhythmias, CHF

Citalopram BBW

May cause suicidal thoughts in children and young adults

Buspirone brand

BuSpar

Buspirone class

Non-benzodiazepine anxiolytic

Buspirone use

Anxiety

Buspirone MOA

Binds to serotonin and D2 receptors

Buspirone dose

20-30 mg PO qD divided BID or TID

Buspirone contraindications

MAO inhibitor use, renal impairment

Buspirone BBW

None

Mirtazapine brand

Remeron

Mirtazapine class

Tetracyclic antidepressant

Mirtazapine use

Major depressive disorder

Mirtazapine MOA

Antagonizes alpha-2 adrenergic and serotonin 5-HT2 receptors

Mirtazapine dose

15-45 mg PO qHS

Mirtazapine contraindications

MAO inhibitor use, avoid abrupt withdrawal

Mirtazapine BBW

May cause suicidal thoughts in children and young adults

What populations are more likely to experience depression?

Women, family history, peaks during adolescence

What are some psychological symptoms of depression?

Depressed mood, anhedonia, sadness, guilt, feelings of worthlessness

What are some physical signs of depression?

Insomnia, sleep disturbance, fatigue, weight changes, changes in appetite, pain, digestive problems, headaches, cramps

What other disease states can produce similar physical symptoms to depression?

Anemia, hypothyroidism, adrenal insufficiency, HIV, sleep apnea

Why are the elderly at risk for depression?

Loneliness, lack of social interaction

In general, what causes depression?

Brain structure dysfunction, imbalance of neurotransmitters

What brain regions are affected in depression?

Prefrontal cortex, hippocampus, amygdala, nucleus accumbens

What regions do we target with electrical stimulation and what effect does it have?

Prefrontal cortex and nucleus accumbens, improve symptoms in medication-resistant depressed patients

Which patients do we use electrode stimulation in?

High risk of commiting suicide, severely depressed, medication-resistant patients

What is dopamine’s physiological function?

Pleasure, mood, emotion, cognitive function, motivation, sex, appetite, aggression

What is norepinephrine’s physiological function?

Energy, mood, emotion, cognitive function, motivation, anxiety, aggression

What is serotonin’s physiological function?

Impulsivity, mood, emotion, cognitive function, sex, appetite, aggression

What is serotonin metabolized by?

MAO

What is the most effective way to increase neurotransmitter levels in the synapse?

Blocking the serotonin reuptake transporter (SERT)

What is the source of serotonergic neurons?

Dorsal raphe nucleus

How are dopamine and norepinephrine metabolized?

COMT, MAO

In general, what causes depression?

Decreased levels of monoamine neurotransmitters

How long does it take for patients to respond to SSRIs?

2-6 weeks

Why are SSRIs the most commonly prescribed antidepressant?

Fewer adverse effects, less dangerous in an overdose

Describe the MOA of SSRIs

SSRIs bind to SERT to increase serotonin levels which causes downregulation of presynaptic inhibitory 5HT1A receptors and stimulation of postsynaptic serotonin receptors resulting in production of BDNF, BDNF if neurotrophic and neuroprotective

What are some adverse effects of SSRIs?

Headache, dizziness, NV, sexual dysfunction, sleep disturbances, akathisia, suicide in children and adolescents, drug interactions

What are symptoms of serotonin withdrawal?

Malaise, muscle aches, chills, fever, sleep disturbances

What are some symptoms of serotonin syndrome?

akathisia, muscle twitches, hyperreflexia, myoclonus, sweating, seizures, coma